Provider Demographics
NPI:1457393092
Name:GYN ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:GYN ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDULGHAFFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-423-0208
Mailing Address - Street 1:101 S WARREN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1147
Mailing Address - Country:US
Mailing Address - Phone:315-423-0208
Mailing Address - Fax:315-423-0255
Practice Address - Street 1:101 S WARREN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1147
Practice Address - Country:US
Practice Address - Phone:315-423-0208
Practice Address - Fax:315-423-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121670207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00536181Medicaid
NY00536181Medicaid